If you have ever looked up at the night sky and recognized Cassiopeia, Orion or the Big Dipper, you know that constellations are patterns seen in the stars. Finding patterns in the stars is a very old practice and was done by many different cultures. Human beings are by nature seekers of patterns. It is a trait that has helped us survive and make sense of the world around us. Science is a method for understanding patterns seen in nature.
Support Your Claims
What are the patterns you have noticed in your surroundings, home or massage therapy studies or practice?
By the time the Renaissance and Age of Enlightenment came around, science was becoming the major force in understanding the world, creating new inventions, and predicting the course of events. The scientific method was used to acquire new knowledge. By forming a question, creating a hypothesis, testing a prediction, analyzing results and drawing a conclusion, both new and old ideas can be examined.
Today, the scientific method remains the most successful way of acquiring new knowledge and in determining the validity of old beliefs.
Research applies creativity to the scientific method. It can be practical or theoretical. It can focus on common everyday concerns or specific unique issues. Research can be done by anyone who understands and applies the principles of the scientific method; it satisfies the curious mind.
Consider how massage therapists might apply the principles of research to further their work. What question would you want to ask? What questions are being asked by others? And what can we say we know scientifically about massage? When we make an assertion about the benefits of massage, what can we offer to support that claim?
Just as when you point out to a friend the truth of a matter by referring to some agreed-upon source, claims made by massage therapists should be supported by evidence. It is through evidence that techniques become more reliable at delivering the expected outcome. It is how theories become established practice and where unreliable practices are discovered and left behind.
Integration into Health Care
An example of research that looks at the benefits of massage was presented during the Massage Therapy Foundation’s (MTF) recent International Massage Therapy Research Conference (IMTRC) in Alexandria, Va., by James Hunter Groninger, MD, FACP, FAAHPM. He serves as MedStar Washington Hospital Center’s Director of Palliative Care, where he conducts patient care, teaches and participates in research activities.
Groninger conducted a study done in collaboration with massage therapists from Healwell, an Arlington, Va.-based nonprofit agency whose mission is to improve the quality of life for people affected by acute, chronic and terminal illness through integrative hands-on therapies, education and research.
They studied the effectiveness of massage therapy on pain and distress relief for hospitalized palliative care patients. A total of 86 patients were enrolled in the study, with 44 of those randomized to the massage therapy treatment group and the others assigned to the control group, which received quiet time. There were no differences in the patients related to age, gender, hospital length of stay or severity of illness.
In measuring the outcomes, there was high satisfaction in both groups for pain relief and preference for intervention. There was significant improvement, however, in pain at 24 hours for the massage therapy group. Would you be able to use this information when consulting with clients or other health care providers?
The same team looked at massage therapy dosing, using three arms: #1 was a 10-minute massage for three days; #2 was a 20-minute massage for three days; #3 was a 20-minute massage for one day. Four-hundred and seven patients received over 1,000 massage therapy sessions during the course of the study.
While the results about dosing are still being evaluated, you can look for them in the near future. Meanwhile, what would your hypothesis be? Would knowing the results of dosing studies help you as you work with clients on treatment plans?
With so much growth and development of the massage profession and therapists working in a variety of settings, it is in the interest of practitioners, the profession and the public that research be embraced as the guiding principle of treatment. Additionally, using quality research supports the integration of massage into the broader health care arena.
Health care systems and insurance providers are reluctant to fund new interventions, such as massage therapy, without a demonstration of beneficial patient outcomes as reflected in quality research studies.
“Despite great efforts, most massage therapy research is considered of relatively low quality due to low subject numbers, mediocre study design and outcomes that are not clinically meaningful (for example, if pain is improved only a little on a pain scale — enough to be statistically significant but not clinically significant — then it doesn’t help the patient/client),” Groninger said.
Massage therapy research is also relatively young and there is still much to learn about framing appropriate questions, developing hypotheses, establishing controls and having qualified massage therapists involved in the study.
“When massage therapists who have been properly trained to work as part of a health care team have the space and support to practice their discipline, we will see that massage therapy contributes to well-being and healing in ways that have been largely unexplored,” said Lauren Cates, executive director of Healwell.
Did you receive much information about research and/or working in a multidisciplinary environment during your massage therapy education? Have you looked for ways to learn more?
Groninger and other therapists at Healwell are now looking at the impact of massage therapy on post-left-ventricular assist device (LVAD) patients.
“Our current study funded by the [MTF], made possible with a grant by the American Massage Therapy Association, will evaluate the role of massage to improve self-efficacy and coping in patients who have just undergone life-changing surgery of a LVAD,” said Groninger.
A left-ventricular assist device is essentially a heart pump that keeps the patient alive and able to function. The surgery is critical and recovery is very challenging. We hypothesize that massage on a regular basis will improve the patient’s sense of self-efficacy (“I can take care of myself.”) and coping (“How do I take care of myself?”).
While you may not have post-LVAD patients presenting in your practice, how could you apply the results of self-efficacy and coping in your work?
Add Value to Treatments
Research alone is not the full story. It is, however, an important component of an evidence-based or evidence-informed practice. The wants, needs and satisfaction of the client as well as the clinical skill and experience of the practitioner are also important.
Together these are central to a high-quality massage and bodywork practice. They integrate the client, practitioner and science into a holistic framework.
The best available evidence adds value to treatments and reduces unwarranted claims. The clients’ interests and expectations are respected and met. Practitioner training, skill and knowledge are applied in the most appropriate ways. The result is a synergy that provides high-quality massage service and treatment.
“When massage therapy is (allowed to be) practiced as a broad discipline that is not limited by a condition-specific protocol, the interpersonal and client-centered adaptation of technique are allowed to demonstrate their real value,” said Cates.
Having research studies that can back up claims made about the efficacy of massage therapy further enhances the value of the practice.
Do you think studies such as the ones mentioned above can be beneficial for your massage therapy practice? How do you plan to use research as you begin your massage therapy career and further develop your skills and knowledge?
“All practitioners want to start out right in their new careers. The best way to do that is by staying up to date on new research findings in order to provide the most effective care possible for the patients/clients,” said JoEllen M. Sefton, PhD, ATC, LAT, a member of the MTF Research Committee.
There is more to say about research and much more to be done. Cates shared the following about the value of research for new practitioners: “Inquiry and curiosity are really valuable. New therapists need to start asking their own questions. What is valuable to know about massage therapy? What don’t we know? What is knowable?
“When we ask questions, we have to be asking ourselves, “How will the answer to this question increase massage therapy’s ability to improve people’s lives and contribute to health care in a way that is uniquely valuable?’”
The more we learn through research, the more we realize how little we know and how much more there is to explore. Be assured the MTF is supporting this effort. Keep your eye out for more information and recommendations in the future on how to use research to enhance your massage therapy sessions and how you, too, can contribute to the body of research studies.
Arthur Veilleux, PT, DPT, OCS, was certified as a massage therapist in 1987. He continued a private massage practice and teaching through physical therapy program graduation in 1993. He received a doctor of physical therapy degree in 2006 and served as an adjunct instructor at the Rutgers University Doctor of Physical Therapy program from 2012–2017.
MK Brennan, RN, MT, recently retired from private practice in massage therapy and nursing. She has been a member of the MTF Writing Group since 2011. She served as president of the Society for Oncology Massage Board, and is a member of the Clinical Working Group and Hospital Based Massage Therapy task force through the Academic Collaborative for Integrative Health.
The MTF is a 501(c)3 public charity, with a mission to advance the knowledge and practice of massage therapy by supporting scientific research, education and community service. This column from the Massage Therapy Foundation provides a road map for massage therapists to learn about studies on massage and understand why involvement in massage research is important in advancing the massage field.